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Journal of Clinical Oncology, Vol 25, No 31 (November 1), 2007: pp. 5024-5026 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2007.13.3751
Response of Intracranial Metastases to Erlotinib TherapySection of Thoracic Oncology, University of New Mexico Cancer Research and Treatment Center, Albuquerque, NM Brain metastases are a common occurrence in non–small-cell lung cancer (NSCLC). The standard treatment is radiation therapy with or without resection, but chemotherapy is only modestly palliative for recurrence within the brain. We describe a 60-year-old nonsmoking Native American woman who presented with left-sided weakness due to a stage IV adenocarcinoma of the lung with multiple brain metastases. The patient received whole-brain radiotherapy (33 Gy in 11 fractions) with resolution of her symptoms, but deferred subsequent chemotherapy. Within 3 months, she became symptomatic again with vertigo, anorexia, and a decrease in her performance status (PS). Magnetic resonance imaging (Fig 1A) revealed recurrent disease within the brain, and a computed tomography scan of the chest (Fig 1B) demonstrated progression of her disease. At this time the patient desired therapy but due to her poor PS (Karnofsky PS, 60) and comorbid disease, she was offered erlotinib 150 mg/d. Within the first month of therapy her symptoms resolved, and her Karnofsky PS improved to 90. A follow-up magnetic resonance imaging of the brain obtained after 8 months of erlotinib therapy (Fig 2A) demonstrated a complete resolution of the brain metastases, and a computed tomography scan of the chest obtained at that time revealed a partial remission of her primary disease (Fig 2B). She continues on erlotinib therapy at this time with only a minimal rash.
The development of brain metastases is usually associated with a poor outcome and shortened survival of 3 to 6 months; treatment is rarely curative. Such patients who receive standard platinum-based chemotherapy may respond to therapy, but these responses are often incomplete and of brief duration.1 Gefitinib, an orally dosed tyrosine kinase inhibitor directed to the epidermal growth factor receptor, has previously demonstrated activity against brain metastases from NSCLC2,3; while it is structurally similar to erlotinib, there is no data demonstrating a survival benefit to gefitinib use, as there is with erlotinib. To date, there have only been two reports of responses of brain metastases from NSCLC in patients receiving erlotinib, although in one patient, the extracranial disease did not respond to erlotinib.4,5 Because a significant number of patients with NSCLC develop brain metastases at some point in the course of their disease, the responses of such patients to epidermal growth factor receptor–targeted therapies are supportive of additional studies to further define the clinical benefit of erlotinib in this situation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors. Employment or Leadership Position: None Consultant or Advisory Role: Dennie V. Jones, Genentech Inc (C) Stock Ownership: None Honoraria: Meera Ravindranathan, Genentech; Dennie V. Jones, Genentech Inc Research Funding: Dennie V. Jones, Genentech Inc Expert Testimony: None Other Remuneration: None
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Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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